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Undiagnosed Symptoms (Expert Forum)
Dyspnea and Malaise
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
Questions in the Undiagnosed Symptoms forum are answered by Dr. Kevin Pho. Topics covered include breathing difficulties, feeling cold, cough, diarrhea, dizziness, fainting, fever, indigestion, itching, nausea, numbness, pain (chronic), paralysis, rash, sweating, swelling, urination problems, and vomiting.
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Dyspnea and Malaise
by danaflowers, May 02, 2007 12:00AM
I am a 20yr old caucasian female of normal weight.
For the past 3 years I've had constant malaise and strong intermittent dyspnea for months at a time that will wake me up at night.
Periods of dyspnea also include low-grade fever, tachycardia, and high blood pressure.
Symptoms have progressed to the point that I am no longer able to work or attend classes and they are worsened with minimal activity and during allergy season.
Pulmicort neb. and Benadryl seem to help dyspnea.
Tests have included: cardiac stress, ANA, RF, endocrine workup, mononucleosis, lyme, B12, and multiple: chest x-rays, chest CTs, CBC, thyroid, mental health screenings, echocardiograms, and pulmonary function tests.
Allergy skin tests and IGE are the only tests that came back positive.
I've been referred to multiple specialists who initially suggest asthma, fibromyalgia, depression/anxiety, or chronic fatigue syndrome but later tell me they are unsure of diagnosis and refer me to another physician.
I've heard that allergies can lead to chronic eosinophilic pneumonia and that it might not show up without BAL- is this possible?
I don't know what else to do and want to return to school as soon as possible.
Thank you.
For the past 3 years I've had constant malaise and strong intermittent dyspnea for months at a time that will wake me up at night.
Periods of dyspnea also include low-grade fever, tachycardia, and high blood pressure.
Symptoms have progressed to the point that I am no longer able to work or attend classes and they are worsened with minimal activity and during allergy season.
Pulmicort neb. and Benadryl seem to help dyspnea.
Tests have included: cardiac stress, ANA, RF, endocrine workup, mononucleosis, lyme, B12, and multiple: chest x-rays, chest CTs, CBC, thyroid, mental health screenings, echocardiograms, and pulmonary function tests.
Allergy skin tests and IGE are the only tests that came back positive.
I've been referred to multiple specialists who initially suggest asthma, fibromyalgia, depression/anxiety, or chronic fatigue syndrome but later tell me they are unsure of diagnosis and refer me to another physician.
I've heard that allergies can lead to chronic eosinophilic pneumonia and that it might not show up without BAL- is this possible?
I don't know what else to do and want to return to school as soon as possible.
Thank you.
Doctor's Answer
by Kevin Pho, MD, May 03, 2007 12:00AM
, May 03, 2007 12:00AM
The tests you have had would rule out many of the major cardiac and pulmonary causes.
Although unlikely, chronic eosinophilic pneumonia is possible despite a negative BAL. Repeating this test or obtaining a second pulmonary opinion can be considered if this is suspected.
At this time, I can't recommend any further tests that haven't already been done. Perhaps chronic PEs can be considered - although I'm sure this has been tested for. Blood tests for d-dimer and a V/Q scan can be considered if suspected.
Otherwise, seeing specialists at a major academic medical center can be considered for further opinions.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Although unlikely, chronic eosinophilic pneumonia is possible despite a negative BAL. Repeating this test or obtaining a second pulmonary opinion can be considered if this is suspected.
At this time, I can't recommend any further tests that haven't already been done. Perhaps chronic PEs can be considered - although I'm sure this has been tested for. Blood tests for d-dimer and a V/Q scan can be considered if suspected.
Otherwise, seeing specialists at a major academic medical center can be considered for further opinions.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
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